硫酸镁在子痫前期治疗中的争议及其不良反应

doi:10.12280/gjfckx.20240157

摘要/Abstract

摘要：

子痫前期是妊娠期导致母儿不良妊娠结局的特发性疾病。解痉是治疗子痫前期的重要且有效手段，硫酸镁是一线解痉药物。目前硫酸镁在治疗子痫前期中仍存在着一些争议，包括：非重度子痫前期是否用硫酸镁治疗，既往研究不推荐应用硫酸镁预防子痫发作，但近年研究认为，子痫前期患者应酌情使用硫酸镁预防子痫；关于产前硫酸镁治疗子痫前期的使用疗程问题，近年研究认为硫酸镁的使用疗程应该小于24 h；产后硫酸镁预防子痫发作，现有的研究支持产后硫酸镁应用可以小于24 h，甚至不使用；硫酸镁使用后相关的不良反应，包括增加母体产后出血风险，引起母体高镁血症、低钙血症，导致新生儿低钙血症、影响骨钙沉积和新生儿高钾血症等。

关键词: 硫酸镁, 先兆子痫, 子痫, 药物相关性副作用和不良反应, 高镁血症, 治疗

Abstract:

Preeclampsia is an idiopathic disease during pregnancy that leads to adverse pregnancy outcomes for both mothers and children. Spasmolysis is an important and effective means to treat preeclampsia, and magnesium sulfate is the first-line spasmodic drug. At present, there are still some controversies about magnesium sulfate in the treatment of preeclampsia, including：whether magnesium sulfate is used for non-severe preeclampsia, magnesium sulfate is not recommended to prevent seizures in previous studies. However, recent studies believe that magnesium sulfate should be used to prevent eclampsia in patients with preeclampsia. Regarding the question of the course of prenatal magnesium sulfate for preeclampsia, several studies in recent years have concluded that the course of magnesium sulfate should be less than 24 h. Postpartum magnesium sulfate can prevent seizures, and existing studies support that postpartum magnesium sulfate application can be less than 24 h or even not used. Adverse reactions associated with the use of magnesium sulfate, including increased maternal postpartum haemorrhage risk, maternal hypermagnesemia, hypocalcemia, neonatal hypocalcemia and bone calcium deposition, neonatal hyperkalemia, etc.

Key words: Magnesium sulfate, Pre-eclampsia, Eclampsia, Drug-related side effects and adverse reactions, Hypermagnesemia, Therapy

赵丽霞, 王小青. 硫酸镁在子痫前期治疗中的争议及其不良反应[J]. 国际妇产科学杂志, 2024, 51(4): 448-452.

ZHAO Li-xia, WANG Xiao-qing. Confused Problem of Magnesium Sulfate in the Treatment of Preeclampsia and Its Adverse Effects[J]. Journal of International Obstetrics and Gynecology, 2024, 51(4): 448-452.

参考文献 26

[1]	Chappell LC, Cluver CA, Kingdom J, et al. Pre-eclampsia[J]. Lancet, 2021, 398(10297):341-354. doi: 10.1016/S0140-6736(20)32335-7.
[2]	Li F, Qin J, Zhang S, et al. Prevalence of hypertensive disorders in pregnancy in China: A systematic review and meta-analysis[J]. Pregnancy Hypertens, 2021, 24:13-21. doi: 10.1016/j.preghy.2021.02.001. pmid: 33626437
[3]	Livingston JC, Livingston LW, Ramsey R, et al. Magnesium sulfate in women with mild preeclampsia: a randomized controlled trial[J]. Obstet Gynecol, 2003, 101(2):217-220. doi: 10.1016/s0029-7844(02)03053-3. pmid: 12576241
[4]	Sibai BM. Magnesium sulfate prophylaxis in preeclampsia: Lessons learned from recent trials[J]. Am J Obstet Gynecol, 2004, 190(6):1520-1526. doi: 10.1016/j.ajog.2003.12.057. pmid: 15284724
[5]	张慧丽, 陈敦金. 美国妇产科医师学会“妊娠期高血压疾病指南”解读[J]. 中华产科急救电子杂志, 2014, 3(1):40-46. doi: 10.3877/cma.j.issn.2095-3259.2014.01.010.
[6]	Berhan Y, Berhan A. Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia[J]. J Obstet Gynaecol Res, 2015, 41(6):831-842. doi: 10.1111/jog.12697.
[7]	Duley L, Henderson-Smart DJ, Walker GJ, et al. Magnesium sulphate versus diazepam for eclampsia[J]. Cochrane Database Syst Rev, 2010, 2010(12):CD000127. doi: 10.1002/14651858.CD000127.pub2.
[8]	Committee Opinion No 652: Magnesium Sulfate Use in Obstetrics[J]. Obstet Gynecol, 2016, 127(1):e52-e53. doi: 10.1097/AOG.0000000000001267.
[9]	Unwaha EA, Bello FA, Bello OO, et al. Intravenous magnesium sulfate in the management of severe pre-eclampsia: A randomized study of 12-hour versus 24-hour maintenance dose[J]. Int J Gynaecol Obstet, 2020, 149(1):37-42. doi: 10.1002/ijgo.13082. pmid: 31833059
[10]	Beyuo TK, Lawrence ER, Kobernik EK, et al. A novel 12-hour versus 24-hour magnesium sulfate regimen in the management of eclampsia and preeclampsia in Ghana (MOPEP Study): A randomized controlled trial[J]. Int J Gynaecol Obstet, 2022, 159(2):495-504. doi: 10.1002/ijgo.14181.
[11]	Sullivan M, Cunningham K, Angras K, et al. Duration of postpartum magnesium sulfate for seizure prophylaxis in women with preeclampsia: a systematic review and meta-analysis[J]. J Matern Fetal Neonatal Med, 2022, 35(25):7188-7193. doi: 10.1080/14767058.2021.1946505.
[12]	Yifu P, Lei Y, Yujin G, et al. Shortened postpartum magnesium sulfate treatment vs traditional 24h for severe preeclampsia: a systematic review and meta-analysis of randomized trials[J]. Hypertens Pregnancy, 2020, 39(2):186-195. doi: 10.1080/10641955.2020.1753067. pmid: 32338165
[13]	Okonkwo M, Nash CM. Duration of Postpartum Magnesium Sulphate for the Prevention of Eclampsia: A Systematic Review and Meta-analysis[J]. Obstet Gynecol, 2022, 139(4):521-528. doi: 10.1097/AOG.0000000000004720. pmid: 35271534
[14]	Vigil-DeGracia P, Ludmir J, Ng J, et al. Is there benefit to continue magnesium sulphate postpartum in women receiving magnesium sulphate before delivery? A randomised controlled study[J]. BJOG, 2018, 125(10):1304-1311. doi: 10.1111/1471-0528.15320.
[15]	Bonnet MP, Garnier M, Keita H, et al. Guidelines for the management of women with severe pre-eclampsia[J]. Anaesth Crit Care Pain Med, 2021, 40(5):100901. doi: 10.1016/j.accpm.2021.100901.
[16]	Miller E, Sakowicz A, Leger E, et al. Association between Receipt of Intrapartum Magnesium Sulfate and Postpartum Hemorrhage[J]. AJP Rep, 2021, 11(1):e21-e25. doi: 10.1055/s-0040-1721671.
[17]	Pergialiotis V, Bellos I, Constantinou T, et al. Magnesium sulfate and risk of postpartum uterine atony and hemorrhage: A meta-analysis[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 256:158-164. doi: 10.1016/j.ejogrb.2020.11.005. pmid: 33246200
[18]	Young S, Wang MJ, Srivastava A, et al. Intrapartum magnesium sulfate exposure and obstetric hemorrhage risk[J]. J Matern Fetal Neonatal Med, 2022, 35(25):10036-10043. doi: 10.1080/14767058.2022.2086796.
[19]	Akbar M, Yoseph D - A, et al. Magnesium intoxication in women with preeclampsia with severe features treated with magnesium sulfate[J]. Hypertens Pregnancy, 2020, 39(3):221-227. doi: 10.1080/10641955.2020.1754851. pmid: 32336169
[20]	Elasy AN, Nafea OE. Critical Hypermagnesemia in Preeclamptic Women Under a Magnesium Sulfate Regimen: Incidence and Associated Risk Factors[J]. Biol Trace Elem Res, 2023, 201(8):3670-3678. doi: 10.1007/s12011-022-03479-x.
[21]	Farahani M, Sharifinejad N, Hashemnejad M, et al. The effect of magnesium sulfate on maternal serum electrolytes and parathyroid hormone in pre-eclampsia[J]. Int J Gynaecol Obstet, 2022, 159(3):938-943. doi: 10.1002/ijgo.14296.
[22]	Tominaga T, Ikeda K, Awazu M. Transient hypercalcemia followed by hypocalcemia in a preterm infant after maternal magnesium sulfate therapy[J]. Clin Pediatr Endocrinol, 2022, 31(2):77-80. doi: 10.1297/cpe.2021-0061.
[23]	Inomata S, Yoshida T, Nagaoka M, et al. Effects of long-term antenatal magnesium sulfate administration on the bone mineralization of preterm infants[J]. J Obstet Gynaecol Res, 2022, 48(12):3119-3127. doi: 10.1111/jog.15430.
[24]	Yada Y, Ohkuchi A, Otsuki K, et al. Synergic interaction between ritodrine and magnesium sulfate on the occurrence of critical neonatal hyperkalemia: A Japanese nationwide retrospective cohort study[J]. Sci Rep, 2020, 10(1):7804. doi: 10.1038/s41598-020-64687-w. pmid: 32385354
[25]	Hira S, Ban R, Ogawa S, et al. Antenatal mgnesium sulfate and ritodrine increased potassium levels in preterm infants: A cohort study[J]. Pediatr Int, 2022, 64(1):e15315. doi: 10.1111/ped.15315.
[26]	Omori-Shimano S, Tominaga T, Ikeda K. Maternal magnesium sulfate administration increases early-onset hyperkalemia risk in premature infants: A propensity score-matched, case-control study[J]. Pediatr Neonatol, 2023, 64(2):119-125. doi: 10.1016/j.pedneo.2022.06.011.